(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2013/132354 A2 12 September 2013 (12.09.2013) P O P C T (51) International Patent Classification: Not classified (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, (21) Number: International Application AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, PCT/IB20 13/00 1032 BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, (22) International Filing Date: DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, 6 March 2013 (06.03.2013) HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, (25) Filing Language: English ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, (26) Publication Language: English NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, (30) Priority Data: TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, 61/607,3 16 6 March 2012 (06.03.2012) US ZM, ZW. (71) Applicants: OSLO UNFVERSITETSSYKEHUS HF (84) Designated States (unless otherwise indicated, for every [NO/NO]; Postboks 450 Nydalen, N-0424 Oslo (NO). kind of regional protection available): ARIPO (BW, GH, AARHUS UNIVERSITY [DK/DK]; Nordre Ringgade 1, GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, DK-8000 Aarhus C (DK). UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, (72) Inventors; and EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, ΓΓ, LT, LU, LV, (71) Applicants : SORLIE, Therese [NO/NO]; Silurveien 53, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, SM, N-0380 Oslo (NO). FRIGESSI, Arnoldo [ΓΓ/ΝΟ]; Ull- TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, evalsveien 52, N-0454 Oslo (NO). BORRESEN-DALE, ML, MR, NE, SN, TD, TG). Anne-lise [NO/NO]; Griniveien 16, N-0756 Oslo (NO). MYHRE, Simen [NO/NO]; Bestumveien 86R, N-0283 Published: Oslo (NO). MOHAMMED, Hayat [ET/NO]; Vaekerovei- — without international search report and to be republished en 75, N-0383 Oslo (NO). OVERGAARD, Jens upon receipt of that report (Rule 48.2(g)) [DK/DK]; Strandvejen 134, DK-8000 Aarhus C (DK). ALSNER, Jan [DK/DK]; Hjulbjergvej 48 C, DK-8270 Hojbjerg (DK). TRAMM, Trine [DK/DK]; Barthsgate 13, 3 .tv, DK-8200 Aarhus N (DK). < (54) Title: GENE SIGNATURES ASSOCIATED WITH EFFICACY OF POSTMASTECTOMY RADIOTHERAPY IN BREAST o CANCER (57) Abstract: The present invention relates to compositions, kits, and methods for providing a prognosis and/or determining a treat - ment course of action in a subject diagnosed with breast cancer. In particular, the present invention relates to gene expression signa tures useful in the prognosis, diagnosis, and treatment of breast cancer. Gene Signatures Associated with Efficacy of Postmastectomy Radiotherapy in Breast Cancer Field of the Invention The present invention relates to compositions, kits, and methods for providing a prognosis and/or determining a treatment course of action in a subject diagnosed with breast cancer. In particular, the present invention relates to gene expression signatures useful in the prognosis, diagnosis, and treatment of breast cancer. Background of the Invention Radiotherapy (RT) is known to prevent loco-regional recurrence (LRR), to favour disease free survival and a long- term improvement on overall survival in high-risk patients suffering from breast cancer [1]. RT is the standard treatment of choice after breast conserving surgery, and recommendations for postmastectomy radiotherapy (PMRT) is well established in patients estimated to have a high risk of local regional recurrence (LRR) (e.g. tumor size > 5 cm, or involvement of > 4 lymph nodes) [2]. For patients with a low risk of LRR, treated with mastectomy, recommendations has for a long time been no RT. The reason for this choice is the general assumption that the survival benefit of PMRT is directly proportional to the reduction in LRR, and hence that RT is only beneficial in patients with high risk of LRR. However, large randomized trials exploring the indications for PMRT to high-risk patients have indicated a substantial overall survival benefit after PMRT also in patients with low risk of LRR, e.g. in patients with involvement of 1-3 positive nodes [3,4]. After several studies [8,9,10,1 1,12] on the largest of these cohorts, the DBCG82 cohort, the positive effect of RT is, however, still speculated to be heterogeneous, and it would be desirable, if a more refined partitioning of patients likely to benefit from RT could be established. Growing evidence gives reason to believe that genetic studies can improve our knowledge in this direction [13,14,15]. At present, estimation of risk of recurrence and subsequent allocation to adjuvant treatment, including RT, is performed though the combination of clinical and pathological parameters and no validated biomarker predicting RT response is standardized and applicable for daily clinical use [13]. Some of the biological factors reported to be directly related to RT resistance mechanisms include micro- environmental influences as e.g. hypoxia, and the resistance in hypoxic tumors towards treatment such as RT is well known and well described. In 2006 Chi et al. [14] published a "Hypoxia-profile", able to divide breast cancers into two groups of either high or low embodiments, the sample is a biopsy sample. In some embodiments, expression levels of nucleic acids (e.g., mR A) or polypeptides of the genes is determined. In some embodiments, expression levels are determined using, for example, microarray analysis, reverse transcriptase PCR, quantitative reverse transcriptase PCR, or hybridization analysis. In some embodiments, the present invention provides methods of providing a prognosis for a subject with breast cancer, selecting a subject with breast cancer for treatment with a particular therapy, determining an increased risk of local recurrence in a subject with breast cancer, or determining an increased risk of distant metastasis in a subject with breast cancer comprising: a) detecting the level of expression of one or more genes (i.e., 1, 2, 2 or more, 3, 3 or more, 4, 4 or more, 5, five or more, 6, 6 or more, 7, 7 or more, 8, 8 or more, 9, 9 or more, 10, 10 or more, 11, 11 or more, 12, 12 or more, 13, 13 or more, or 14) selected from the group consisting of HLA-DQA, RGS1, DNALI1, IGKC, ADH1B, hCG2023290, OR8G2, C3orf29, ZCCHC17, RTCDl, VANGLl, DERP6, FLJ37970, and RAFl in a sample from a subject diagnosed with breast cancer; and b) comparing the expression of the one or more genes with a reference expression level for the one or more genes, wherein an altered level of expression relative to the reference provides an indication selected from the group consisting of the likelihood of disease free survival, the likelihood of local recurrence, the likelihood of distant metastasis, and an indication that the subject is a candidate for treatment with a particular therapy. In some embodiments, the detecting the level of expression of one or more genes comprises determining an expression profile for one or more genes selected from the group consisting of HLA-DQA, RGS1, DNALI1, IGKC, ADH1B, hCG2023290, and OR8G2. In some embodiments, an increased level of expression of HLA-DQA, RGS1, DNALI1 and a decreased level of expression of IGKC, ADH1B and OR8G2 is associated with an increased risk of local recurrence of breast cancer. In some embodiments, the detecting the level of expression of one or more genes comprises determining an expression profile for one or more genes selected from the group consisting of C3orf29, ZCCHC17, RTCDl, VANGLl, DERP6, FLJ37970, and RAFl. In some embodiments, an increased level of expression of one or more of genes selected from the group consisting of C3orf29, ZCCHC17, RTCDl, VANGLl, DERP6, FLJ37970, and RAFl is associated with an increased risk of local recurrence of breast cancer. In some embodiments, the methods further comprise the step of determining a treatment course of action based on the level of expression. In some embodiments, the treatment course of action is administration of post mastectomy radiation. In some embodiments, the treatment course of action is based on a CSVI score calculated from the expression levels, wherein the ¾ " + ¾ . In some embodiments, a negative CVSI score is indicative of a positive response to the post mastectomy radiation and a positive score is indicative of a negative response to the post mastectomy radiation. In some embodiments, decreased expression of HLA-DQA, RGS1, DNALI1 and hCG2023290 and increased expression of IGKC, ADH1B and OR8G2 is associated with an increased benefit of radiation therapy. In some embodiments, altered expression of one or more genes selected from the group consisting of IGKC, RGS1 and DNALI1 is associated with increased risk of distant metastasis in the subject. In some embodiments, the sample is a biopsy sample. In some embodiments, the detecting comprises contacting a sample from the subject with at least informative reagent specific for the one or more genes. In some embodiments, the detecting an expression level comprises detecting the level of nucleic acid of the genes in the sample. In some embodiments, the detecting the level of nucleic acid of the genes in the sample comprises detecting the level of mRNA of the genes in the sample. In some embodiments, the detecting the level of expression of the genes comprises a detection technique selected from the group consisting of microarray analysis, reverse transcriptase PCR, quantitative reverse transcriptase PCR, and hybridization analysis.